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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314104
Report Date: 01/11/2024
Date Signed: 01/11/2024 11:30:32 AM

Document Has Been Signed on 01/11/2024 11:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:IZADPANAH, ELMIRAFACILITY NUMBER:
304314104
ADMINISTRATOR:IZADPANAH, ELMIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 295-7927
CITY:LADERA RANCHSTATE: CAZIP CODE:
92694
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
01/11/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:LicenseeTIME COMPLETED:
12:00 PM
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A Required - 3 Year inspection was conducted at the facility by Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek. LPA met with licensee, Elmirah Izadpanah and her assistant, Alan Roberts. LPA observed 5 children of whom 4 children were under 2 years of age. Licensee was operating within the licensed capacity for Large Family Childcare Home as specified on license.
A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are two adults including the licensee and no minor children living in the facility. Facility Day care hours of operation is Monday through Friday from 7:00 am-6:00 pm.
During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to childcare children. Off limits areas are made inaccessible by means of baby gates and locks. The childcare area consists of family room, dinning room, children's bathroom, front yard and backyard on the downstairs area. There is a gate installed in front of the kitchen to make it inaccessible to children There is a gate installed in the family room which has separated the space from the dinning area. There is one bedroom upstairs designated for napping children. LPA observed 4 cribs and 4 cots in that bedroom. The licensee stated she would stay upstairs during nap time in that bedroom. LPA reminded that one adult shall supervise napping children and shall stay on the same level of the house and physically observe children every 15 minutes and log it on the napping log for children under 24 months old. The licensee stated either herself or her assistant stay in the room during nap time with children. The garage and the rest of upstairs (two other bedrooms and bathrooms, laundry room) are off limits and are inaccessible to children by installing a gate on the bottom of the stairs and one gate on the top of the stairs. There is one entertainment room on the 3rd floor which is off limit and there is a gate in front of the entrance to the 3rd floor. There is a dog (papillon mix Breed living in the house.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: IZADPANAH, ELMIRA
FACILITY NUMBER: 304314104
VISIT DATE: 01/11/2024
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Main childcare room is accessed upon entering the home. There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger to children were not readily available to children they were stored inaccessible to children, none were observed during inspection. Licensee stated there is no firearm in the facility. There is no pets at the house. There is a diaper changing table in the bathroom. LPA reminded the licensee that children shall not be left unattended on the changing table during diaper changing.
LPA verified there is a working telephone service (cellular service). Licensee stated, they use back patio and backyard for outdoor play. The outdoor area was fenced. There are no bodies of water on the premises.
The licensee does have a current roster of children in care. Fire Drill log was reviewed and the last one was conducted on 7/17/2023. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. LIC 9227 was reviewed. The log for very 15 minutes check on napping children under 24 months old was not available. (Total of 5 files were reviewed).
The licensee's Pediatric CPR/First Aid certification and her assistant's cards are current. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family childcare home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for licensee, measles for licensee and her assistant were within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years. Licensee's and her assistants' mandated reporter training certificates are current.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-
CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
The licensee understands she must be present in the facility and must ensure children in care are always
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: IZADPANAH, ELMIRA
FACILITY NUMBER: 304314104
VISIT DATE: 01/11/2024
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supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.
Licensee, Elmirah Izadpanah was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated. LPA discussed the safe sleep regulations with Licensee, Elmirah Izadpanah and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed Licensee, Elmirah Izadpanah of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Licensee, Elmirah Izadpanah was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-care- licensing/subscribe and select the Child Care option to receive email communication. (The licensee is already signed up for this purpose). In the areas that were evaluated, the following deficiency was observed of the California Code of Regulations, Title 22, Division 12. Please refer to LIC 809D. A notice of site visit was given to licensee, Elmirah Izadpanah and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the licensee, Elmirah Izadpanah. End of report
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/11/2024 11:30 AM - It Cannot Be Edited


Created By: Mahnaz Malek On 01/11/2024 at 10:58 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IZADPANAH, ELMIRA
FACILITY NUMBER: 304314104

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 4 counts of 4 files under 24 months old which posed a potential health, and safety to persons in care. The log for every 15 minutes check was not available for 4 infants.
POC Due Date: 01/12/2024
Plan of Correction
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The licensee agreed to documents every 15 minutes check on children under 24 months old and send verification to LPA's email address by the due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Thuy Ho
LICENSING EVALUATOR NAME:Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2024


LIC809 (FAS) - (06/04)
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